Smoking a Dangerous Addiction: A Systematic Review on an Underrated Risk Factor for Oral Diseases

Abstract

Despite growing knowledge of the adverse effects of cigarette smoking on general health, smoking is one of the most widely prevalent addictions around the world. Globally, about 1.1 billion smokers and over 8 million people die each year because of cigarette smoking. Smoking acts as a source for a variety of oral and systemic diseases. Various periodontal issues such as increased pocket depth, loss of alveolar bone, tooth mobility, oral lesions, ulcerations, halitosis, and stained teeth are more common among smokers. This systematic review was conducted according to the guidelines from PRISMA, and research articles were retrieved from the Web database sources on 31 May 2021. The quality of research articles was ensured by the type of evidence from combined schema incorporating as schema-13 evidence type description, Cochrane health promotion and public health field (CHPPHF), and the health gains notation framework-14 screening question for quality assessment of qualitative and quantitative studies. Smokers have been found to have bleeding on probing, periodontal pockets, and clinical attachment loss compared to nonsmokers. Oral and respiratory cancers are among the most lethal known diseases caused by cigarette smoking and other commonly occurring sequelae such as stained teeth, periodontal diseases, etc.

Oral Health Behaviors and Oral Health-Related Quality of Life Among Dental Patients in China: A Cross-Sectional Study

“…This study showed that participants who reported smoking or drinking had a higher OHIP-5 score, which is consistent with the findings of Baskar doss et al 37 Previous studies have confirmed that smoking is a risk factor for periodontal disease, and some studies have shown that traditional cigarettes have a more severe impact on oral mucosal lesions than e-cigarettes, 38 but it is worth noting that e-cigarettes are also a risk factor for oral health (OR= 1.78, 95% CI: 1.39–2.30; P<0.001), 39 which is also capable of damaging tooth enamel and leading to deterioration of periodontal health, 40 and smoking is prone to various periodontal problems such as increased alveolar depth, alveolar bone loss, calculus formation, oral lesions, ulcers, halitosis, and tooth staining, 41 and the formation of tobacco plaque facilitates the attachment of more calculus and soft tartar The formation of tobacco plaque facilitates the adhesion and deposition of more calculus and tartar, and the large amount of toxic and harmful components in tobacco can also directly stimulate local periodontal tissues, thus leading to gingival recession; alcohol consumption may cause changes in the oral microenvironment, resulting in dysbiosis of the oral flora, thus causing periodontitis and gum disease, 42 , 43 and has been shown to have synergistic carcinogenic effects with smoking.…”

Oral microbiota dysbiosis accelerates the development and onset of mucositis and oral ulcers

“…Smoking can inhibit the phagocytosis of macrophages and neutrophils by inhibiting bacterial stimulated expression of superoxide and surface receptors (e.g., TLR2), thus weakening the clearance of newly colonized microorganisms. Meanwhile, smoking may also induce the receptor activator of nuclear factor- κβ Ligand (RANKL) to upregulate the levels of IL-1 and IL-6, affecting the oral immune response to the microbiota ( Matthews et al, 2012 ; Ahmed et al, 2021 ), as shown in Figure 2 . In addition, smoking also changes the microbiota in the oral mucosa by affecting biofilm formation and adhesions of specific microorganisms (e.g., Staphylococcus aureus and Streptococcus pneumoniae ) ( Kulkarni et al, 2012 ; Mutepe et al, 2013 ).…”

Effect of e-cigarettes on oral health and the development of periodontitis

“…The relationship between conventional cigarette smoking and various oral health diseases has long been established in scientific literature. 5,6 E-cigarettes contain varying nicotine concentrations and a wide range of flavor additives, all of which have been linked to harmful oral health conditions. A large sample study revealed that the combined use of cigarette smoking and e-cigarettes were related to self-reported poor oral health conditions.…”